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Dalton JC, Plichta JK. Paget's disease of the breast: Insights from imaging to guide surgical management. Am J Surg 2024; 231:16-17. [PMID: 38521673 DOI: 10.1016/j.amjsurg.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/09/2024] [Accepted: 03/10/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Juliet C Dalton
- Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27707, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27707, USA; Duke Cancer Institute, Duke University, 10 Bryan Searle Drive, Durham, NC, 27710, USA; Department of Population Health Sciences, Duke University Medical Center, 215 Morris St, Durham, NC, 27701, USA.
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2
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Northgraves M, Cohen J, Harvey J, Huang C, Palmieri C, Pinder S, Roy P, Reynia S, Soares M, Cain H. A randomised controlled trial of Pre-Operative Oncotype DX testing in early-stage breast cancer (PRE-DX study) - Study protocol. PLoS One 2024; 19:e0300339. [PMID: 38489298 PMCID: PMC10942020 DOI: 10.1371/journal.pone.0300339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The Oncotype DX® Breast Recurrence Score assay can guide recommendations made to patients with oestrogen receptor positive (ER+), human epidermal growth factor receptor 2 negative (HER2-) breast cancer regarding post-surgery adjuvant therapy. Standard practice is to order the test in the post-operative setting on a specimen from the excised invasive carcinoma. However, it has been shown to be technically possible to perform the test on the diagnostic core biopsy. By testing the diagnostic core biopsy in the pre-operative setting, the wait for excised invasive carcinoma Recurrence Score results could be reduced allowing patients to be more accurately counselled regarding their treatment pathway sooner with any adjuvant treatment recommendations expedited. This would allow for more efficient streaming of follow up appointments. The aim of this study is to compare the impact on the patient treatment pathway of performing the Oncotype DX® test on the diagnostic core biopsy pre-operatively (intervention) as opposed to the excised invasive carcinoma (control). METHODS AND ANALYSIS This parallel group randomised controlled trial aims to recruit 330 newly diagnosed patients with grade 2 or grade 3, ER+, HER2-, invasive intermediate risk early-stage breast cancer. Participants will be randomised 2:1 to the preoperative testing of the diagnostic core biopsy compared to the post-operative testing of the excision specimen. The primary endpoint is number of clinical touchpoints between treating team and patient from initial approach until offer and prescription of the first adjuvant treatment. Secondary endpoints include time from diagnosis to offer and prescription of the first adjuvant treatment, patient-reported anxiety scores and health cost impact analysis collected at baseline, following the post-operative clinic and following the offer of adjuvant treatment, and number of alterations in treatment sequence from original planned surgical treatment to neoadjuvant therapy. TRIAL REGISTRATION The study was registered on ISRCTN (ISRCTN14337451) on the 16th August 2022.
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Affiliation(s)
| | - Judith Cohen
- Hull Health Trials Unit, University of Hull, Hull, United Kingdom
| | - James Harvey
- Nightingale Breast Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Chao Huang
- Hull Health Trials Unit, University of Hull, Hull, United Kingdom
- Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, United Kingdom
| | - Carlo Palmieri
- Institute of Systems, Molecular and Integrative Biology, Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Sarah Pinder
- School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- Department of Cellular Pathology, Guy’s and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Pankaj Roy
- Department of Breast Surgery, Oxford University Hospitals NHS Foundation Trust, Oxfordshire, United Kingdom
| | | | - Marta Soares
- Centre for Health Economics, University of York, York, United Kingdom
| | - Henry Cain
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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3
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Mukhtar RA, Huppert L, Ramalingam K. Letter to the Editor of Annals of Surgical Oncology concerning "Is Choosing Wisely Wise for Lobular Carcinoma in Patients over 70 Years of Age? A National Cancer Database Analysis of Sentinel Node Practice Patterns". Ann Surg Oncol 2024; 31:401-402. [PMID: 37851197 DOI: 10.1245/s10434-023-14474-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023]
Affiliation(s)
- Rita A Mukhtar
- Department of Surgery, Diller Family Comprehensive Cancer Center, UCSF Helen, San Francisco, USA
| | - Laura Huppert
- Division of Hematology/Oncology, Diller Family Comprehensive Cancer Center, UCSF Helen, San Francisco, USA
| | - Kirithiga Ramalingam
- Department of Surgery, Diller Family Comprehensive Cancer Center, UCSF Helen, San Francisco, USA.
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4
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Elleson KM, Englander K, Gallagher J, Chintapally N, Sun W, Whiting J, Mallory M, Kiluk J, Hoover S, Khakpour N, Czerniecki B, Laronga C, Lee MC. Factors Predictive of Positive Lymph Nodes for Breast Cancer. Curr Oncol 2023; 30:10351-10362. [PMID: 38132388 PMCID: PMC10742655 DOI: 10.3390/curroncol30120754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Axillary node status is an important prognostic factor in breast cancer. The primary aim was to evaluate tumor size and other characteristics relative to axillary disease. MATERIALS AND METHODS Single institution retrospective chart review of stage I-III breast cancer patients collected demographic and clinical/pathologic data from 1998-2019. Student's t-test, Chi-squared test (or Fisher exact test if applicable), and logistic regression models were used for testing the association of pN+ to predictive variables. RESULTS Of 728 patients (mean age 59 yrs) with mean follow up of 50 months, 86% were estrogen receptor +, 10% Her2+, 78% ER+HER2-negative, and 10% triple-negative. In total, 351/728 (48.2%) were pN+ and mean tumor size was larger in pN+ cases compared to pN- cases (mean = 27.7 mm versus 15.5 mm) (p < 0.001). By univariate analysis, pN+ was associated with lymphovascular invasion (LVI), higher grade, Her2, and histology (p < 0.005). Tumor-to-nipple distance was shorter in pN+ compared to pN- (45 mm v. 62 mm; p< 0.001). Age < 60, LVI, recurrence, mastectomy, larger tumor size, and shorter tumor-nipple distance were associated with 3+ positive nodes (p < 0.05). CONCLUSIONS Larger tumor size and shorter tumor-nipple distance were associated with higher lymph node positivity. Age less than 60, LVI, recurrence, mastectomy, larger tumor size, and shorter tumor-nipple distance were all associated with 3+ positive lymph nodes.
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Affiliation(s)
- Kelly M. Elleson
- Regional Breast Care, Genesis Care Network, 8931 Colonial Center Dr #301, Fort Myers, FL 33905, USA
| | - Katherine Englander
- Morsani College of Medicine, University of South Florida, Tampa, Fl 33602, USA (N.C.)
| | - Julia Gallagher
- Morsani College of Medicine, University of South Florida, Tampa, Fl 33602, USA (N.C.)
| | - Neha Chintapally
- Morsani College of Medicine, University of South Florida, Tampa, Fl 33602, USA (N.C.)
| | - Weihong Sun
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA (C.L.)
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Melissa Mallory
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA (C.L.)
| | - John Kiluk
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA (C.L.)
| | - Susan Hoover
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA (C.L.)
| | - Nazanin Khakpour
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA (C.L.)
| | - Brian Czerniecki
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA (C.L.)
| | - Christine Laronga
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA (C.L.)
| | - Marie Catherine Lee
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA (C.L.)
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Huang K, Jakub J, Gabriel E, Moreno-Aspitia A, McLaughlin S. Overall Survival Following Neoadjuvant Chemotherapy Versus Adjuvant Chemotherapy in Clinically Node Negative T1 Triple Negative Breast Cancer. Ann Surg Oncol 2023; 30:7026-7035. [PMID: 37490162 DOI: 10.1245/s10434-023-13977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The purpose of this study was to compare the overall survival (OS) of upfront surgery followed by adjuvant chemotherapy (ACT) versus neoadjuvant chemotherapy (NACT) followed by surgery in patients with clinical T1 clinically node negative triple negative breast cancer (TNBC). PATIENTS AND METHODS We retrospectively reviewed 48,329 women with cT1N0 TNBC from 2006 to 2016 in the National Cancer Database (NCDB). Patients were categorized into five pathologic subgroups based on ACT versus NACT and definitive pathologic stage after surgery: ACT with unchanged stage (pT0-1N0), ACT with pathologic upstage (any nodal disease, > pT1N0), NACT with pCR (ypT0-isN0), NACT with stable disease (SD) (ypT1N0), and NACT with progressive disease (PD) (any nodal disease, > ypT1N0). The primary outcome was 5 year OS. RESULTS Patients with TNBC who underwent upfront surgery followed by ACT had better OS compared with those who received NACT (p < 0.001). The hazard ratio (HR) for death for NACT compared with ACT was 1.42 (95% CI 1.26-1.59, p < 0.001) on multivariate analysis. Patients who underwent upfront surgery followed by ACT and whose pathological stage was unchanged from clinical stage had similar outcomes compared with those who received NACT and attained pCR with 5 year OS of 92.7% versus 93.3% (p = 0.34). Patients with clinical T1cN0 tumors who underwent NACT with pCR had better outcomes compared with those who underwent ACT with unchanged stages. (p = 0.025). CONCLUSIONS For cT1N0 TNBC patients, OS of upfront surgery followed by ACT was not inferior to those who underwent NACT. Neoadjuvant chemotherapy was associated with better outcomes in cT1c patients who attained pCR.
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Affiliation(s)
- Kai Huang
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - James Jakub
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Emmanuel Gabriel
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Alvaro Moreno-Aspitia
- Jacoby Center for Breast Health, Division of Hematology Oncology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Sarah McLaughlin
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
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Moore JL, Patterson NH, Norris JL, Caprioli RM. Prospective on Imaging Mass Spectrometry in Clinical Diagnostics. Mol Cell Proteomics 2023; 22:100576. [PMID: 37209813 PMCID: PMC10545939 DOI: 10.1016/j.mcpro.2023.100576] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/22/2023] Open
Abstract
Imaging mass spectrometry (IMS) is a molecular technology utilized for spatially driven research, providing molecular maps from tissue sections. This article reviews matrix-assisted laser desorption ionization (MALDI) IMS and its progress as a primary tool in the clinical laboratory. MALDI mass spectrometry has been used to classify bacteria and perform other bulk analyses for plate-based assays for many years. However, the clinical application of spatial data within a tissue biopsy for diagnoses and prognoses is still an emerging opportunity in molecular diagnostics. This work considers spatially driven mass spectrometry approaches for clinical diagnostics and addresses aspects of new imaging-based assays that include analyte selection, quality control/assurance metrics, data reproducibility, data classification, and data scoring. It is necessary to implement these tasks for the rigorous translation of IMS to the clinical laboratory; however, this requires detailed standardized protocols for introducing IMS into the clinical laboratory to deliver reliable and reproducible results that inform and guide patient care.
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Affiliation(s)
| | - Nathan Heath Patterson
- Frontier Diagnostics, Nashville, Tennessee, USA; Vanderbilt University Mass Spectrometry Research Center, Vanderbilt University, Nashville, Tennessee, USA
| | - Jeremy L Norris
- Frontier Diagnostics, Nashville, Tennessee, USA; Vanderbilt University Mass Spectrometry Research Center, Vanderbilt University, Nashville, Tennessee, USA
| | - Richard M Caprioli
- Frontier Diagnostics, Nashville, Tennessee, USA; Vanderbilt University Mass Spectrometry Research Center, Vanderbilt University, Nashville, Tennessee, USA; Departments of Biochemistry, Pharmacology, Chemistry, and Medicine, Vanderbilt University, Nashville, Tennessee, USA.
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Soegaard Ballester JM, Finn CB, Ginzberg SP, Kelz RR, Wachtel H. Thyroid cancer pathologic upstaging: Frequency and related factors. Am J Surg 2023; 226:171-175. [PMID: 37019808 PMCID: PMC10518023 DOI: 10.1016/j.amjsurg.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/01/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Histopathologic assessment of thyroid tumors can lead to stage migration. We assessed frequency of pathologic upstaging, and associations with patient and tumor factors. METHODS Primary thyroid cancers treated between 2013 and 2015 were included from our institutional cancer registry. For tumor, nodal, and summary stage, upstaging was present when final pathologic stage was greater than clinical staging. Multivariate logistic regression and Chi-squared tests were performed. RESULTS 5,351 resected thyroid tumors were identified. Upstaging rates for tumor, nodal, and summary stage were 17.5% (n = 553/3156), 18.0% (n = 488/2705), and 10.9% (n = 285/2607), respectively. Age, Asian race, days to surgery, lymphovascular invasion, and follicular histology were significantly associated. Upstaging was significantly more common after total vs partial thyroidectomy, for tumor (19.4% vs 6.2%, p < 0.001), nodal (19.3% vs 6.4%, p < 0.001), and summary stages (12.3% vs 0.7%, p < 0.001). CONCLUSIONS Pathologic upstaging occurs in a considerable proportion of thyroid tumors, most commonly after total thyroidectomy. These findings can inform patient counseling.
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Affiliation(s)
| | - Caitlin B Finn
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA.
| | - Sara P Ginzberg
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA.
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, USA.
| | - Heather Wachtel
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, USA.
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Wei Y, Li Y, Chen Y, Liu P, Huang S, Zhang Y, Sun Y, Wu Z, Hu M, Wu Q, Wu H, Liu F, She T, Ning Z. ALDH1: A potential therapeutic target for cancer stem cells in solid tumors. Front Oncol 2022; 12:1026278. [PMID: 36387165 PMCID: PMC9650078 DOI: 10.3389/fonc.2022.1026278] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/12/2022] [Indexed: 12/02/2022] Open
Abstract
Solid tumors can be divided into benign solid tumors and solid malignant tumors in the academic community, among which malignant solid tumors are called cancers. Cancer is the second leading cause of death in the world, and the global incidence of cancer is increasing yearly New cancer patients in China are always the first. After the concept of stem cells was introduced in the tumor community, the CSC markers represented by ALDH1 have been widely studied due to their strong CSC cell characteristics and potential to be the driving force of tumor metastasis. In the research results in the past five years, it has been found that ALDH1 is highly expressed in various solid cancers such as breast cancer, lung cancer, colorectal cancer, liver cancer, gastric cancer, cervical cancer, esophageal cancer, ovarian cancer, head,and neck cancer. ALDH1 can activate and transform various pathways (such as the USP28/MYC signaling pathway, ALDH1A1/HIF-1α/VEGF axis, wnt/β-catenin signaling pathway), as well as change the intracellular pH value to promote formation and maintenance, resulting in drug resistance in tumors. By targeting and inhibiting ALDH1 in tumor stem cells, it can enhance the sensitivity of drugs and inhibit the proliferation, differentiation, and metastasis of solid tumor stem cells to some extent. This review discusses the relationship and pathway of ALDH1 with various solid tumors. It proposes that ALDH1 may serve as a diagnosis and therapeutic target for CSC, providing new insights and new strategies for reliable tumor treatment.
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Affiliation(s)
- Yaolu Wei
- School of Basic Medicine Sciences, Xianning Medical College, Hubei University of Science and Technology, Xianning, China
| | - Yan Li
- School of Basic Medicine Sciences, Xianning Medical College, Hubei University of Science and Technology, Xianning, China
| | - Yenan Chen
- Xianning Medical College, Hubei University of Science and Technology, Xianning, China
| | - Pei Liu
- Xianning Medical College, Hubei University of Science and Technology, Xianning, China
| | - Sheng Huang
- Xianning Medical College, Hubei University of Science and Technology, Xianning, China
| | - Yuping Zhang
- School of Basic Medicine Sciences, Xianning Medical College, Hubei University of Science and Technology, Xianning, China
| | - Yanling Sun
- School of Basic Medicine Sciences, Xianning Medical College, Hubei University of Science and Technology, Xianning, China
| | - Zhe Wu
- School of Basic Medicine Sciences, Xianning Medical College, Hubei University of Science and Technology, Xianning, China
| | - Meichun Hu
- School of Basic Medicine Sciences, Xianning Medical College, Hubei University of Science and Technology, Xianning, China
| | - Qian Wu
- School of Basic Medicine Sciences, Xianning Medical College, Hubei University of Science and Technology, Xianning, China
| | - Hongnian Wu
- School of Basic Medicine Sciences, Xianning Medical College, Hubei University of Science and Technology, Xianning, China
| | - Fuxing Liu
- School of Basic Medicine Sciences, Xianning Medical College, Hubei University of Science and Technology, Xianning, China
- *Correspondence: Fuxing Liu, ; Tonghui She, ; Zhifeng Ning,
| | - Tonghui She
- School of Basic Medicine Sciences, Xianning Medical College, Hubei University of Science and Technology, Xianning, China
- *Correspondence: Fuxing Liu, ; Tonghui She, ; Zhifeng Ning,
| | - Zhifeng Ning
- School of Basic Medicine Sciences, Xianning Medical College, Hubei University of Science and Technology, Xianning, China
- *Correspondence: Fuxing Liu, ; Tonghui She, ; Zhifeng Ning,
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Goyal S, Jacob LA, Lokanatha D, Suresh Babu MC, Lokesh KN, Rudresha AH, Saldanha S, Amirtham U, Thottian AGF, Rajeev LK. Discordance in clinical versus pathological staging in breast cancer: Are we undermining the significance of accurate preoperative staging in the present era? Breast Dis 2021; 41:115-121. [PMID: 34420937 DOI: 10.3233/bd-201029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The present era of individualized treatment for breast cancer is influenced by the initial disease status including the anatomical extent, grade, and receptor status. An accurate preoperative staging is the basis of treatment planning and prognostication. Our study aims to determine the discordance between the preoperative clinical and the postoperative pathological stages of breast cancer patients. METHODOLOGY The medical records of all non-metastatic breast cancer patients from January 2017 to December 2018 who underwent upfront surgery were reviewed. They were staged as per the eighth AJCC and the concordance between the clinical (c) and pathological T (tumor), N (nodal), and final AJCC stage was studied. A Chi-square test was used to determine factors that significantly correlate with disease discordance. RESULTS A total of 307 breast cancer patients were analyzed. Among these, 43.3% were hormone receptor-positive, 30.6% were Her2 positive and 26% were triple-negative. Overall stage discordance was seen in 48.5% (n = 149) patients (upstaging in 22.1%, downstaging in 26.4%). The discordance rate was 48.9% for T stage (cT versus pT) and 57.4% for N stage (cN versus pN). Among patients with clinically node-negative disease, 53.4% were found to have positive nodes on histopathology, while 27.2% had vice versa. Overall, the factors associated with upstaging were ER-positive, Her2 positive and triple-negative status (all p < 0.05), while none of the factors showed significant association with downstaging. CONCLUSIONS About half of breast cancer patients had discordance between clinical and pathological staging with higher discordance in the nodal stage. This changes the disease prognosis, and may also affect the offered surgical treatment and radiotherapy. Thus highlighting the need for a precise pre-operative staging. Also, this information will aid clinicians in discussions with patients, keeping in mind the likelihood of change in disease staging and management.
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Affiliation(s)
- Shina Goyal
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Linu Abraham Jacob
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - D Lokanatha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - M C Suresh Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - K N Lokesh
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - A H Rudresha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Smitha Saldanha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Usha Amirtham
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Antony G F Thottian
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - L K Rajeev
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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10
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Wu DY, Spangler AE, de Hoyos A, Vo DT, Seiler SJ. Quality of Anatomic Staging of Breast Carcinoma in Hospitals in the United States, With Focus on Measurement of Tumor Dimension. Am J Clin Pathol 2021; 156:356-369. [PMID: 33899092 DOI: 10.1093/ajcp/aqaa240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES We investigated the accuracy of clinical breast carcinoma anatomic staging and the greatest tumor dimension measurements. METHODS We compared clinical stage and greatest dimension values with the pathologic reference standard values using 57,747 cases from the 2016 US National Cancer Institute Surveillance, Epidemiology, and End Results program who were treated by surgical resection without prior neoadjuvant therapy. RESULTS Agreement for clinical vs pathologic anatomic TNM group stage, overall, is 74.3% ± 0.4%. Lymph node N staging overall agrees very well (85.1% ± 0.4%). Based on tumor dimension and location, T staging has an agreement of only 64.2% ± 0.4%, worsening to 55% without carcinoma in situ (Tis) cases. In approximately 25% of cases, pathologic T stage is higher than clinical T stage. The mean difference in the greatest dimension is 1.36 ± 9.59 mm with pathologic values being generally larger than clinical values; pathologic and clinical measurements correlate well. T-stage disagreement is associated with histology, tumor grade, tumor size, N stage, patient age, periodic biases in tumor size measurements, and overuse of family T-stage categories. Pathologic measurement biases include rounding and specimen-slicing intervals. CONCLUSIONS Clinical and pathologic T-staging values agree only moderately. Pathologists face challenges in increasing the precision of gross tumor measurements, with the goal of improving the accuracy of clinical T staging and measurement.
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Affiliation(s)
- Dolly Y Wu
- Department of Volunteer Services, University of Texas Southwestern Medical Center, Dallas, TX, USA
- California Institute of Technology, Pasadena, CA, USA
| | - Ann E Spangler
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alberto de Hoyos
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dat T Vo
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Stephen J Seiler
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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11
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Ali B, Mubarik F, Zahid N, Sattar AK. Clinicopathologic Features Predictive of Distant Metastasis in Patients Diagnosed With Invasive Breast Cancer. JCO Glob Oncol 2021; 6:1346-1351. [PMID: 32886558 PMCID: PMC7529503 DOI: 10.1200/go.20.00257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE National Comprehensive Cancer Network and European Society for Medical Oncology guidelines suggest screening for distant metastasis (M1) in symptomatic patients or those with locally advanced breast cancer. These guidelines are based on studies that often used pathologic staging for analysis. Physician variability in screening for M1 has also resulted in overuse of diagnostic tests. We sought to identify clinicopathologic features at diagnosis that could guide testing for metastatic disease. METHODS Patients diagnosed with invasive breast cancer between January 2014 and December 2015 were identified from our institutional database. Demographic and clinical variables were collected, including receptor profiles and clinical TNM staging. Rates of upstaging for each clinical stage and rates of concordance of pathologic and clinical staging were analyzed. Univariate analysis and multivariate regression analysis (P < .05) identified predictors of upstaging to stage IV disease. RESULTS A total of 370 patients met the inclusion criteria. Seventy patients (18.9%) had metastatic disease at diagnosis. The rate of upstaging for stages I, IIA, IIB, and III were 0%, 5.6%, 18.8%, and 36.6%, respectively. Advancing clinical stage, tumor size, and nodal status resulted in a significantly higher rate (P < .001) of upstaging to M1 disease. Age and hormone receptor status were not associated with upstaging to stage IV disease. Clinical stages I-III were concordant with pathologic staging in 65(42.8%) of 152 patients (kappa’s index, 0.197; P < .000). CONCLUSION Advancing clinical stage, tumor size, and nodal status at diagnosis were predictive of upstaging to M1 disease in patients with breast cancer. Distant metastatic workup should be considered in patients with clinical stage IIB disease or higher.
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Affiliation(s)
- Basim Ali
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan; and Baylor College of Medicine, Waco, TX
| | | | - Nida Zahid
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Abida K Sattar
- Department of Surgery, Aga Khan University, Karachi, Pakistan
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Mukhtar RA, Boughey JC. ASO Author Reflections: Changes in Primary Treatment Strategy for Invasive Lobular Carcinoma Highlight the Need for Better Predictors of Therapy Response. Ann Surg Oncol 2021; 28:5878-5879. [PMID: 33704606 DOI: 10.1245/s10434-021-09730-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Rita A Mukhtar
- Department of Surgery, Diller Family Comprehensive Cancer Center, UCSF Helen, University of California San Francisco, San Francisco, CA, USA.
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